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Healthcare Basic Plans

Gold

Plan Details (In-Network)

Coverage Level: Gold

PCP Copay: $30 Copay after deductible

Deductible: $150

Out-Of-Pocket Max: $5,100

Office Visit: coinsurance: No Charge, copay: $30 Copay after deductible

Prescription Drugs: coinsurance: No Charge, copay: $15 Copay after deductible

Emergency Room: coinsurance: 20% Coinsurance after deductible, copay: $250 Copay after deductible

Maternity: coinsurance: 20% Coinsurance after deductible, copay: $500 Copay after deductible

Silver

Plan Details (In-Network)

Coverage Level: Silver

PCP Copay:$30 Copay after deductible

Deductible:$1,400

Out-Of-Pocket Max:$6,000

Office Visit: coinsurance: No Charge, copay: $30 Copay after deductible

Prescription Drugs: coinsurance: No Charge, copay: $15 Copay after deductible

Emergency Room: coinsurance: 20% Coinsurance after deductible, copay: $250 Copay after deductible

Maternity: coinsurance: 20% Coinsurance after deductible, copay: $500 Copay after deductible

Bronze

Plan Details (In-Network)

Coverage Level: Bronze

PCP Copay: No Charge after deductible

Deductible: $6,350

Out-Of-Pocket Max: $6,350

Office Visit: coinsurance: No Charge, copay: No Charge

Prescription Drugs: coinsurance: No Charge, copay: No Charge after deductible

Emergency Room: coinsurance: No Charge after deductible, copay: No Charge

Maternity: coinsurance: 40% Coinsurance after deductible, copay: $500 Copay after deductible

Multi-State Gold

Plan Details (In-Network)

Coverage Level: Gold

PCP Copay: $30 Copay after deductible

Deductible: $150

Out-Of-Pocket Max: $5,100

Office Visit: coinsurance: No Charge, copay: $30 Copay after deductible

Prescription Drugs: coinsurance: No Charge, copay: $15 Copay after deductible

Emergency Room: coinsurance: 20% Coinsurance after deductible, copay: $250 Copay after deductible

Maternity: coinsurance: 20% Coinsurance after deductible, copay: $500 Copay after deductible

 


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527 South Rose Street | Kalamazoo, MI 49007 | 800.872.8409 Powered by Insurance Website Builder

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